Abstract P149: Self versus Emergency Medical Service Transport for Patients With ST-Elevation Myocardial Infarction: Findings From the National Cardiovascular Data Registry ACTION - Get With the Guidelines

Background: Guidelines recommend expedited transport via emergency medical services (EMS) to facilitate early triage and reperfusion of patients with ST-elevation myocardial infarction (STEMI). Yet, a significant proportion of patients still present to the hospital via self-transportation. Methods: We examined rates of self- vs. EMS-transport for 33,678 STEMI patients treated at 348 hospitals in the ACTION Registry-GWTG between Jan 07 and Jun 09. Patients transferred in from outside hospitals to ACTION participating hospitals were excluded. Using generalized estimating equations (GEE) logistic regression model, we examined independent factors associated with patient self (vs. EMS) transportation. We further compared differences in reperfusion use and timing between these two groups. Results: A total of 13,479 STEMI patients (40%) self-transported to the hospital. Sociodemographic factors associated with self- (vs. EMS-) transportation include younger age, male sex, Hispanic ethnicity, and non-white race ( Table ). In contrast, the presence of cardiovascular risk factors were largely associated with EMS- rather than self-transport. Self-transport patients had longer delays from symptom onset to hospital arrival (median time 120 vs. 90 min, p<0.0001), lower rates of reperfusion (93.0 vs. 94.5%, p<0.0001), and longer delays to reperfusion (median door-to-balloon time 76 vs. 64 min, p<0.0001, median door-to-needle time 30 vs. 23 min, p<0.0001). Conclusion: A substantial proportion of STEMI patients in contemporary practice self-transport to the hospital and this mode of transport is associated with delays in reperfusion therapy compared with EMS transport. Since younger age, non-white race, and male sex are significantly associated with self-transport, community education efforts should target these groups and should be integrated with system-wide strategies designed to improve timely access to reperfusion care. Factors associated with self-transport versus EMS-transport Sociodemographic variables Adjusted χ2 OR 95% CI p-value Age ( per 5 yr. decrease) 187 1.06 1.05-1.08 <0.0001 Male (vs. female) 46 1.19 1.13-1.26 <0.0001 Hispanic ethnicity 32 1.37 1.23-1.52 <0.0001 Race (vs. white) 12 0.0022 Black/African American 1.21 1.09-1.34 Asian/American Indian 1.12 0.95-1.34 Insurance status (vs. private) 22 <0.0001 Medicare/Medicaid/Military/VA 0.89 0.84-0.94 Self/none 0.86 0.80-0.93 Clinical variables Heart failure symptoms on presentation 89 0.68 0.62-0.73 <0.0001 Prior PCI 24 0.84 0.78-0.90 <0.0001 Prior stroke 23 0.78 0.70-0.86 <0.0001 Prior CABG 13 1.18 1.08-1.29 0.0003 * Other variables included in this model: prior CHF, DM, prior MI, BMI, dyslipidemia, currently on dialysis, and HTN